Terapia de hemadsorción perioperatoria en endocarditis infecciosa: revisión sistemática y metaanálisis

Abstract

Infective endocarditis (IE) is a systemic disease with multiorgan involvement. It is a severe disease, which frequently requires surgical treatment, despite which mortality rates can be high due to complications related to an uncontrolled systemic inflammatory response and/or sepsis. Hemadsorption systems such as Cytosorb® allow the removal of proinflammatory cytokines and endotoxins to improve the prognosis of these patients. We performed a systematic review in Pubmed and Cochrane to identify controlled comparative studies of the perioperative use of Cytosorb® in patients undergoing cardiac surgery for IE. A meta-analysis was performed comparing different clinical outcomes. 9 studies were finally included in the meta-analysis. The use of hemadsorption therapy did not reduce mortality in the early postoperative period (RR = 0.75; p = 0.05). Both, the duration of mechanical ventilation (mean difference = -6.91 hours; p = 0.01) and the duration of support with vasopressor drugs (mean difference = -34.47 hours; p = 0.03) were significantly shorter in the case of patients treated with hemadsorption. However, postoperative stays, the incidence of postoperative renal failure or the need for surgical revision due to bleeding did not show differences between groups. To conclude, the use of the Cytosorb® hemadsorption filter in cardiac surgery for IE allowed better control of postoperative inflammatory activity, with lower requirements for vasopressor support and duration of mechanical ventilation, but without impact on perioperative mortality or other related complications.